Sexual health and behaviors in homosexual, bisexual and heterosexual Danes: baseline findings in the Project SEXUS cohort study.

Background: Population-based studies on the sexual health and behaviors of sexual minorities are scarce.

Aim: To assess and compare sexual health and behaviors among homosexual, bisexual, and heterosexual Danes.

Methods: We analyzed questionnaire data from 59 838 participants age 15-89 in the Project SEXUS study, including 1577 homosexuals, 1500 bisexuals, and 56 761 heterosexuals. Sex-specific logistic regression analyses with heterosexuals as reference yielded demographically weighted, confounder-adjusted odds ratios (aORs) for measures of sexual health and behaviors.

Outcomes: Study-specific and internationally validated sexual outcome measures.

Results: Compared with heterosexuals, lesbians were less likely to have had sex with another person in the last year. In contrast, sex partner numbers and frequencies of masturbation and porn consumption were higher among gay and bisexual men and bisexual women. Premature ejaculation was less common among gays (aOR, 0.50; 95% CI, 0.32, 0.81) and bisexual men (aOR, 0.62; 95% CI, 0.41, 0.93), whereas erectile dysfunction was more common among gays in the last 4 weeks (IIEF-5 score ≤ 11) (aOR, 3.01; 95% CI, 1.42, 6.38) and among both gays (aOR, 2.88; 95% CI, 1.87, 4.43) and bisexuals (aOR, 1.91; 95% CI, 1.24, 2.92) in the last year. Also, gays more often reported orgasmic dysfunction (aOR, 1.80; 95% CI, 1.09, 2.99). Overall female sexual dysfunction (FSFI-6 score ≤ 19) was less common among lesbians (aOR, 0.63; 95% CI, 0.40, 0.98) and bisexuals (aOR, 0.65; 95% CI, 0.48, 0.89), although vaginal cramp dysfunction was more common in bisexuals (aOR, 2.16; 95% CI, 1.15, 4.06). Gay and bisexual men and bisexual women reported more sexual risk indicators, with particularly high odds of sexual victimization among gays (aOR, 5.74; 95% CI, 3.72, 8.85), bisexual men (aOR, 5.03; 95% CI, 3.36, 7.54), and bisexual women (aOR, 2.67; 95% CI, 2.25, 3.16). Finally, gay and bisexual men were more often dissatisfied with the appearance of their bodies and genitals.

Clinical implications: Health professionals should be aware of the greater burden of sexual health challenges among gay men and bisexual individuals.

Strengths and limitations: Strengths include the large size, broad coverage, and national representativeness of our study. Limitations include a modest response rate (34.6%), the potential for self-selection and information biases, and uncertain generalizability to other countries.

Conclusion: In this Danish study, lesbians exhibited no unusual burden of sexual risk indicators, and sexual dysfunctions along with sexually transmitted infections were less common in this group. In contrast, gay men and bisexuals of both sexes reported significantly more risky sexual behaviors, sexual victimization, sexual dysfunctions, and other adverse outcomes, calling for further investigation and increased clinical attention.